As you no doubt know already, the public option as an essential element
of healthcare reform has been under sustained attack. Not only did the town hall Astroturf commandos decry the
public option as part of a “government takeover” of healthcare, but soon
afterward, the insider oddsmakers in Washington declared the public option
dead-on-arrival, even as a substantial majority of the House of Representatives
supported it, along with most Americans polled on the subject.

While the public option would provide competition the
private health insurance market currently lacks, it’s become clear that passage
of it will be a monumental task in the Senate. One way to do it would be by the same method President
George W. Bush got both of his huge tax cuts for the super rich: by using
“reconciliation,” a parliamentary procedure that bypasses the promised filibuster
by the Republican minority. While
the reconciliation process has been used by both Democrats and Republicans, the
current Senate majority and the President are reluctant to push through a
monumental healthcare bill without any Republican support.

Other options to pass healthcare with either no public
option or a severely hobbled version of it are viewed as a cop-out on the
promise to truly reform the system.
With all the momentum gathered to pass a healthcare bill this year, it
would leave tremendous disenchantment among supporters to end up with a bill
that didn’t actually make the health insurance market more competitive and
affordable for most Americans. It
would be particularly hard to explain to those who now lack affordable
insurance and the easier access to care it provides.

There are those who argue that any substantial reform that
includes the nationwide elimination of “pre-existing conditions” and moves
towards full participation will eventually lead to a better system… over
time. They posit that what isn’t
passed now will be easier to obtain once healthcare is viewed as a right by
most Americans and the reform process continues over the coming years. This position doesn’t address all those
whose health is endangered today by a lack of healthcare or by poverty produced
by a bankrupting experience with illness.

Now, there appears to be another option to pass a reform
bill with a public option, but without the highest level of conflict— a public
option with a state-by-state opt-out provision. Nate Silver at fivethirtyeight.com has posted some reasons
to consider a public option with an opt-out for states that choose not to offer
the choice to their citizens. I’ll
be honest, I haven’t explored comments on the proposal outside of Silver’s on
the subject, but at first glance, it sounds like the best compromise short of a
“clean” public option bill. It has
the beauty of leaving the workings of the public option alone (not hobbling it
as other compromises would do) yet making it more politically palatable to
Senators who fear voting for its inclusion universally.

As Silver notes, making the public option the ‘default
choice’ would be a powerful way to encourage most states to remain
opted-in. The presence of the
public option in most areas would encourage even conservative states to offer
this alternative that would be available to residents of nearby states. And the power of the public option
where is would actually be in effect would be undiluted. No hobbled plan to make the insurance
companies happy. The main
attraction of the public option—the negotiating power to offer care at low
rates— would remain.

Perhaps this is the “magic bullet” necessary to pass a
true reform bill. Maybe not. But meanwhile, outspoken progressive
support for the public option remains the only bulwark between the insurance
lobby and a Senate cave-in to their demands.

Two of my colleagues at the other place I post, Buck
Naked Politics,
are based in Florida, the home of the dimpled chad. For a decade, we’ve
all been cringing when we hear they have an election down there. Will
they elect another member of the Bush family, or someone like Kathleen Harris,
unable to discern the difference between serving the Bushes and performing her
responsibility to voters? Perhaps they’d send us another a moral-majority
type like Mark Foley, leading one (creepy) life for himself and espousing
another very conservative set of rules for the rest of us? Who would
Floridians send to Washington next?

Well, thanks to Damozel and Deb, I’ve noticed that
they’ve now served up a refreshing Florida surprise down there in Congressman
Alan Grayson, a freshman Democrat from the Orlando area. Perhaps the
Sunshine State has spawned some real cultural changes over the last decade— and
we may all be better off for it. While most of the country is still
sending timid negotiators or know-nothing naysayers to the floor of the
Congress, Florida has delivered us a legislator who wants to focus attention on
some basic realities about the battle for progressive change.

When confronted with a Republican chorus of “start
over,” “no government in my healthcare,” and “let’s not rush into change,”
Grayson decided after eight months in Washington to fight fire with fire.
He stood up in the well of the House and called Republicans on the content of
their healthcare plans… or rather the total lack of any plan in their
obstructionism. He described the Republican plan in three parts:

1- Don’t Get Sick

2- If You DO Get Sick…

3- …Die Quickly

Many media pundits quickly criticized Grayson for
incivility and several Republicans took him literally, demanding hilariously to
know when he had heard any of them actually asking particular people to
die. But, in truth, Grayson exposed the incredible double-standard that’s
been at play in the healthcare debate, in which the Right simply calls the
President names— and then twists reform into descriptions of ‘death panels’ and
a looming Big Brother, while Democrats (with a few notable exceptions) turn
around and defensively parry these outrageous statements with gentle
rejoinders, charts, and graphs. The effect of this dynamic is to make
healthcare reform look unpopular and ultimately doomed, despite continued
grassroots support for a public option and for real change.

One thing I’ve learned living in New York: when the
people you’re fighting with stop fighting fair, you better take off the gloves
too, or you’re gonna be lying in the gutter soon, wishing you had.
Grayson has spent the last week responding to calls about his
attention-grabbing parody by citing just how dangerous it is to do nothing
about our broken healthcare system. It’s actually fatal to 4,400 people
every year. That’s right, people die in this country all the time because
they have no insurance. If we’re planning on waiting till every
Republican is happy with a compromise plan, many more Americans will die for
lack of health insurance—and that’s simply unacceptable, Grayson says.

Until now, the healthcare debate has featured
passion on the Right and mostly compromise, vacillation, and gentle persuasion
by reform proponents. Congressman Grayson has just pointed out that in
order to make change, it might be necessary to some people go away mad, so the
rest of us can move forward and make a better America. It’s way past time
for us be disengaged while the reactionaries and talk radio celebrities grab
headlines with pitchforks, placards, and shouldered shotguns. If we want
change, we better realize, as Grayson has, that it’s not gonna come easy, or
gently, but only with resolve and a willingness to fight ignorance with truth—
and backbone.

UPDATE— In the same vein as the post above, Paul Krugman writes today (Monday) in the NYTimes about thenew position of the Republican Party:attack anything that might look like success for the other side, no matter what ideological inconsistency might be necessary.Scorched Earth.The new black.

Nicholas Beaudrot at Donkeylicious has put together a flow
chart, based on a visualization by Chris Hayes, that helps keep the basics of the public option in perspective for the 200+ million Americans whom it will not affect in the slightest.Many of these people will be the same
people who are shouting about it at Town Halls across the country.

I’m a little tired of the stories about the righteous
indignation of conservative America regarding healthcare reform and the
“socialist takeover” of the country.I can only conclude that these folks have been sleepwalking through the
last year and have somehow been miraculously reanimated by Rush Limbaugh and
Newt Gingrich as zombies for the health insurance industry.The indignation thing ought to be the
territory of the rest of us, who’ve been ripped off by conservative leaders and
their corporate backers for years and left to fend for ourselves when we’re
ill, uncovered, or changing jobs.

A “socialist takeover” is the farthest thing from what’s
going on.The healthcare reform
now under consideration is a mild form of universal care, which would neither
fix all the problems of healthcare in America nor break the health insurance
industry’s hold on our dollars.We
deserve better, but at minimum we need the public option pivotal to most
current reform bills.Apparently,
that’s too much government for the insurance industry and the conservatives who
cater to their needs, but the public option is about the only thing that will
give many Americans without health coverage a chance to increase their access
to care.

A public option is also the only thing that will prevent
the 14,000 people currently losing their health insurance every day in America from losing their
access to good medical care.Those
of us who are woefully undercovered by high-deductable plans would also be
helped by a public option, allowing us better benefits for our limited
dollars.The public option might
also help spur more competition within the private insurance market, since
companies now providing coverage would have to make their products attractive
to consumers able to stack their benefits up against an plan that would not be
looking to constantly increase profits.

The other benefit of a public option would be its lack of
incentive to disqualify customers for specious reasons.One of the ways private insurers
increase their profits is by denying coverage dollars to individuals for the
most mercenary and small violations of the insurance contract or dragging
decisions out to dissuade the individual from seeking an expensive procedure,
putting themselves between the patient and her doctor.A public insurer without incentive to
deny benefits would be attractive to many and might be matched by health
insurers wishing to remain competitive with it.They might need to find new ways to show their policies
actually are more worthwhile when the consumer really needs them!

Another possible development in the wake of a public
option’s advent might be to encourage the founding of more non-profit
healthcare clinics.Preventive
public health care, now less available than it should be, would be much more
cost-effective for poor families. This care is far less than expensive than
untimely emergency room visits, which the poor often use for health crises left
untreated for too long.If
coverage was not an issue for many Americans strapped for cash, we would be far
more likely to seek out preventive medicine.The increase in preventive care would also make hospital
emergency room waiting times somewhat less onerous and allow for better
emergency care.

While the private market may be able to innovate and
provide new ways of approaching coverage to make the average person healthier
and less healthcare-poor, there is little incentive for insurers to do so
now.The healthcare system is
broken for too many; we need more basic guarantees.Americans want to stop making employment decisions and
career plans based on health coverage.We need to join the rest of the developed world in decoupling healthcare
from specific jobs and employment— and make our best plans portable and
continuous.

In short, we need major progress.Let’s let our legislators know that we
aren’t part of the blind rage of the televised Right-Wing Town Hall mobs.We elected a new President in part
because he promised to reform healthcare, not in spite of that promise.We voted for change last year.Now it’s time to demand that we get
some when it counts.

Rick
Scott, the former chairman of Columbia Hospital Corporation, a for-profit chain
of hospitals, is the founder of an organization called “Conservatives for
Patients’ Rights.”CPR (cute,
huh?) is now funding protests like the ones we see at health care reform town
hall meetings across the country—at which Congresspeople are being shouted down, scuffles started, and
people routinely intimidated by mobs of frightened birther/wingnuts.

His
campaign is coordinated by CRC Public Relations, the same PR firm that
masterminded the 2004 Swift Boat campaign against presidential candidate John
Kerry.What’s more interesting,
Scott’s own personal history in the healthcare industry shows how the current
system can be gamed by those who would bilk the public.Scott was forced out of the Columbia
Hospital Corporation in 1997 by its board after being identified with massive
overbilling and kickbacks for which the company ended up paying the $1.7
billion in fines.

As our President-Elect said during the campaign (while his
opponent was ‘suspending’ his campaign to save the economy), the President
often has to deal with more than one thing at a time.There’s no doubt that our imploding domestic economy is Job
One for the incoming Chief Executive, but there are other crises he must
address— and the death spiral in Zimbabwe is one that requires urgent attention from world leaders.

Bob Herbert’s columntoday in the NY Times details, anecdotally, the extent of the ongoing epidemics in Zimbabwe, accompanied by an
almost total lack of health services in this country, which is still today
under dictator Robert Mugabe’s iron fist, despite elections and an unfulfilled
agreement to share power with the victor.The situation there strains belief in its seriousness.Every day that it remains unaddressed
involves a mounting— and preventable— loss of life.

“A major problem is the loss of life and fetal
wastage we are seeing with obstetric patients. They come so late, the fetuses
are already dead. We see women with eclampsia who have been seizing for 12
hours. There is no intensive care unit here, and now there is no intensive care
in Harare.“If we had intensive care, we know it would be immediately
full of critically ill patients. As it is, they just die.”

Herbert excerpts the report in his column at length and
paints a picture as frightening as any international crisis on the world scene,
most of which are covered daily, unlike Zimbabwe’s:

“This emergency is so grave that some entity needs to step
in there and take over the health delivery system,” said Susannah Sirkin, the
deputy director of Physicians for Human Rights.

I
encourage readers to look at Herbert’s excellent piece and to go directly to
the organization’s report itself at the link.If you are moved to do so, there are a number of ways to let
the incoming Administration know that you share the group’s concern about the
disaster in Zimbabwe.Here are
some links that can be useful:

It’s now clear that Obama isn’t considering a serious delay in pushing healthcare reform in 2009. With Tom Daschle’s appointment to head HHS, it’s full speed ahead for Ted Kennedy and Max Baucus to put together legislation in the Senate that will finally bring universal health coverage to the United States. Some speculate that the bill may not become effective until the Bush tax cuts for the rich expire in 2011, but the shape and scope of the new plan will likely become clear to everyone early in 2009.

This signal is obviously setting conservatives’ hair on fire, but they won’t be the biggest obstacles to passage. The insurance industry has a huge political war chest banked and they’ll be using it to pay lobbyists and threaten legislators. Expect to see the fruits of that spending soon enough in news coverage, think tank pronouncements, PAC formations, and industry nay-sayers appearing on the talk show circuit. The health insurance companies are doubtless readying a new round of scary commercials like the “Harry and Louise” series that helped kill reform in the early 1990’s— and that will just be the most public part of the effort.

Extending health coverage to all Americans will be job two for the new administration, now that the nation has plunged into a dramatic recession and financial crisis, but it looks like Obama isn’t planning on putting off the healthcare discussion till another day. Passing a universal coverage bill quickly would be a Reaganesque move which sets the table for a powerful Presidency that is able to accomplish big things and sets its sights on major issues. Failing at healthcare reform, on the other hand, would cripple Obama right away. It’ll be a mother-of-all-battles, happening at the same time Obama must deal with an economy on the edge.

If you think the election year has been dramatic, just wait till after the Inauguration. Fasten your seat belts, folks...

I’ve spent a fair amount of ink this past week on Sarah Palin, but aside from what her appointment says about John McCain, she’s probably not make-or-break in the Presidential race. Whether you believe it’s a boldly maverick move to bring along someone with no experience of national politics and barely any experience of statewide office or whether it just seems a tad strange to you that a candidate with so much gravitas himself would trust the country, in the event of his demise, to someone with none to speak of, Sarah Palin’s not the issue.

The main issue in the race for the Presidency seems to be whether the country has had enough of what got us where we are or whether we’re ready to chance that more of the same policies might yield better results in the future. The country is in pretty hard economic times. People are losing their homes and jobs at a fast enough clip to make one wonder whether things might just be getting worse still. $600 stimulus checks haven’t stopped a rising unemployment rate and the failure of several banks, a major investment house, two major mortgage lenders, and other predatory ones.

Tax cuts for the rich have drained the fat of the land into the coffers of those with the ability to invest it anywhere in the world they like, while workers real wages have stagnated and their jobs continue to disappear abroad. Health savings accounts provide tax deductible cash for elective treatments and health club memberships— if you can afford them— while tens of millions of harder pressed citizens can’t afford to get an annual checkup without health insurance.

We’re besieged in the opinion of the world. We haven’t found a way to unite the country around shared values some seven years after being attacked by a small gang of terrorists and five and one half years after attacking a country those terrorists didn’t come from in response. Most of the policies our government has pursued seem to be like rubber to Al Queda and glue for our troops bogged down in internal sectarian conflicts halfway around the world.

We’ve been through the drowning of a great American city and we now have a candidate who shared his birthday celebration with President Bush as it happened, but he later said he’d have landed Air Force One at the nearest base to New Orleans if he’d been the Commander-in-Chief. The city is still at risk from hurricane flooding and some tens of thousands of its residents even now are unable to reoccupy their homes.

We have a continuing assault on the civil liberties that made America the beacon of democratic hope around the world. We have a government that has institutionalized torture as a way to fight those would subject our troops and civilians to torture themselves and called it a necessary ‘dark side’ to war. When confronted with evidence that illegal imprisonments and torturous interrogations were being executed without deference to the Constitution’s ban and international agreements’ prohibition of them, our President merely waved away inconvenient facts— and dared the judiciary to enforce their rulings.

When confronted with unpleasant facts, this Administration has responded with character assassination and even by revealing covert identities of covert agents to retaliate against critics. When Administration figures were convicted of crimes involved, the President’s response was to commute any meaningful sentence against his Vice President’s aide and describe him in glowing terms.

The same Administration that puffs so loudly about terror 24/7 spends little energy securing nuclear materials around the world and putting salve on the conflicts that make their eventual use a little more likely every day. While they invaded a country supposedly to pre-empt nuclear proliferation with manufactured evidence, the government as a whole is pathetic in its inability to address the spread of nuclear materials for profit and ideology from sites around the world.

The last seven years of inaction against climate change and energy dependence on foreign oil have sunk the entire planet into a tailspin from which we don’t really know we’ll recover. One thing about the current energy and environmental mess we do know is that it was utterly predictable. In fact, the scientists who told us it would happen worked for the government in some cases. But the current Administration muzzled them, lest their cries of alarm trouble the citizenry about their strong support for the petroleum barons who put them in power. And now, the successor to the throne of the party in power leads chants of “Drill, Baby, Drill,” as a solution to the problem.

Even against this backdrop and years of backing the President, Mr. McCain hopes the country will still think of him as somehow separate from the party and the policies he’s endorsed and supported for Mr. Bush. He hopes that voters are more interested an ambience of freshness emanating from an unknown and appealing woman from the North and that they will fear another unknown, what a new and very different President might mean for their future.

If Americans are distracted enough by the hoopla about war heroism and the snarky things said about community organizing and supposed elitism to forget all that we’ve been through over the past seven years of hard right policies, perhaps America will be getting what it wants and deserves. Otherwise, this coming election ought to be a referendum on whether those policies have worked out so well for us.